This economic downturn is still unfolding, with multiple cascading effects on the constituencies and funding of nonprofits. Because this development comes at a moment when a new administration is at the helm of our nation—with different ideas about how nonprofits and government might interact—the Nonprofit Quarterly decided to document your experiences to understand what this notable moment in history will mean for the nonprofit sector.
So as this era unfolds, we are asking NPQ readers to volunteer their organizations to be followed over the coming months. This article is the first of a series that chronicles the ways in which ordinary but enormously entrepreneurial U.S. nonprofits adapt in the face of enormous complexity and rapid change.
In short, we have found that the degree to which nonprofits are affected is dependent not only on the field they occupy, which we expected, but also very much on their geography.
Is their state budget in good or bad shape? Is the local economy thriving or waning? Does the organization occupy an area with a lot of philanthropy or not so much? These differences are set against a backdrop of profound change on a national basis that manifests differently in different localities.
But going from the macro to the micro level, there is also the variable of the nonprofit’s situation pre-crisis. Did the organization have reserves? Did it already suffer from chronic problems, such as reimbursement rates that remained flat for years or a board that can’t distinguish between a run-of-the-mill cash flow crisis and a full-blown financial meltdown? Do its funders give project-specific or general operating grants? Is the board exhausted or energized by the challenge that lies ahead?
And finally, there is an immeasurable ingredient of the determination and focus of leadership. Mix it all up, and you’ll get a sense of the rapidity with which and the extent to which nonprofits now feel the pain and the rapid, critical decisions that are required of them.
Christ Community Health Services
Christ Community Health Services (CCHS), a federally qualified health center in Memphis, Tennessee, has had a notable course in this recession. In December, when it became concerned about the downturn, the organization eliminated eight positions (at the time, three of which were vacant and five of which were occupied). Although these positions represented about 5 percent of its workforce, CCHS avoided eliminating positions that were involved in direct–service delivery to clients. Then, in March, the organization was asked to apply for a half-million dollars of federal money under the stimulus package. The turnaround time for the grant was approximately one week, and the money was to be made available in another two weeks. The grant will allow CCHS to do more of what it already does: deliver health services to the very poor in Memphis, Tennessee.
Burt Waller, the executive director, has been at the 14-year-old organization since its pre-growth years when it was still small and “felt like a family.” So has the current chairperson of the board, who was in the founding group. Despite the group’s modest beginnings, Christ Community Health Services was in the right place at the right time; it was faith based and a health center, both of which were priority areas for the George W. Bush administration. In 2002, CCHS was designated a federally qualified health center. Quickly thereafter it grew tenfold, from a $1.5 million budget to an annual $15 million budget. Before that Waller says that it had been in and out of “dire financial straits and in a situation in which the organization could have failed at any time.” In fact, had there been a different group of employees at CCHS, the organization might long ago have been declared DOA. Prior to 2001 and the change in the organization’s finances, staff members even took out second mortgages on their homes to lend CCHS money when the going got tough.
In the organization’s current financial mix, Waller worries about the increasing proportion of CCHS’s patient load that is uninsured and the fact that this will likely increase the number of people who pay at reduced rates. But he does not worry about the center’s line of credit, which can creep into the million-dollar range but then be paid down shortly thereafter. Tennessee’s Medicare program TennCare has gotten as much as six months behind on its payments (Waller admits to some fear during such times) making the almost constant use of the organization’s line of credit necessary. Fortunately, a couple of local hospital systems guarantee the credit line, which means that CCHS can spend more time focusing on the needs of those it serves rather than responding to the worries of bankers relatively unfamiliar with its business.
Over the next few years, Waller expects more growth because local hospitals want to see CCHS expand as a primary health-care provider and because federal interest in the issue of health care access is so high. Waller’s biggest concern in that growth is about talent. “We need providers [doctors and nurses] who can hit the ground running,” he says, “and our salaries are still not at all competitive.” He is also concerned about the fact that the center has not yet made the transition to electronic patient records but thinks that in the near future money may be made available for this shift if all progresses as he expects.
CCHS aspires to have the recommended three months of reserves. It now has only 30 days’ worth.
Family Health Partnership Clinic
The Family Health Partnership Clinic (FHPC) in Woodstock, Illinois, which also provides health services to the very poor, is only a year younger than Christ Community Health Services. This clinic is located in McHenry County, a community with a much higher per–capita income than Memphis, which means that it can’t access the most obvious form of federal support for community health providers. As a result, the organization operates primarily with volunteer medical providers, and the number of volunteer providers it has dictates the number of patients that can be seen.
“The county has gone from being primarily agricultural to being much more settled out,” says Suzanne Hoban, FHPC’s executive director. She continues:
There are many more housing developments from which people commute to Chicago. At one point, it was the fastest-growing county in Illinois. It has a very high per-capita income, but this ends up masking a lot of the poverty that actually exists within the county. The other thing that makes this different from surrounding counties is that there’s not one major city or town that dominates. There’s a series of towns in the county, and so the poverty is diffused throughout the county, and there’s not one census tract that we can look at and say, “That’s where all of our patients live; that’s where the poverty is.”
And so that has precluded us from getting any kind of state or federal funding for medical services, because we don’t qualify. In a neighboring city, like, for example, in Chicago, you can look at certain census tracts and see huge areas of poverty. So the state or the feds will be able to designate that area as a medically underserved area, and they will qualify for state and federal funding. Poverty here is spread out.
The Family Health Partnership Clinic serves either underemployed or unemployed people who can’t afford the cost of insurance. Patients are 60 percent Hispanic. The clinic’s fees are based on income and family size, but “we never turn anyone away” says Hoban. “Our only criterion is that you can’t be covered by insurance.” Of late, unfortunately, this has resulted in more patient need than can be served. “Most people pay between $10 and $15 for a visit that it costs us $100 to provide.”
Like, Christ Community Health Services, FHPC had a rocky start. As its founder, Hoban says, she tried to start the organization three times before it actually got off the ground. But once it got started, the patient load far exceeded projections. “When we first started out, we thought we would see somewhere between 500 and 1,000 patient visits a year, but now we are upwards of 7,800 patient visits a year.” The resultant increased need for volunteers to feed the core of its program has engendered an energetic and creative volunteer recruitment program. Using trade publications, Facebook, wine tastings, and partnerships with local hospitals and other health-related organizations, FHPC is in constant recruitment mode.
Recently, when it became overrun with chronic-care patients, FHPC faced the possibility of having to suspend its services to new patients. “It was a crisis, and we had to find new providers. So I went to the head of the primary-care practice at the local hospital and built a small plan that has resulted in eight more doctors,” Hoban says.
Here’s how we did it: The hospital has several physician practices. What we found out is that for the first two years, when a physician joins that practice, they’re on salary. After that point, they’re on a productivity type of a reimbursement, [which is] very common for physicians. So we said to them, you know, while they are on salary, their practices aren’t particularly busy. They wouldn’t lose any money if you encouraged them to come over here on work time, and it would still allow them to build up their practice, and it would keep people out of the emergency room; it would be a win-win situation for everybody. And at the end of two years—after they go on their other type of reimbursement—if they still want to volunteer here, that’s great, but they don’t have to. But wouldn’t it be a wonderful community service if you let your new docs come over here for three hours a month? And they agreed to that.
It’s really no skin off the hospital’s nose, because it’s not that those practices are full to begin with. And it’s no skin off the docs’ nose, because they’re not doing it on their time off, you know, they’re doing it during work time, but it does make a huge difference in terms of the community, and in terms of access to care, and in terms of clogging the emergency rooms with people who don’t need to be in the emergency room.
Of course, bringing on new doctors has created the need for additional nurses and space. Hoban says that the clinic has a donor that is willing to kick $1 million into a capital campaign for a new building, but the organization really needs $3 million, and the time, she says, is not right to launch into such a project.
The clinic’s fundraising has not suffered to date, but Hoban says she is holding her breath. What’s her trick for managing during tough times? She gives the board a deficit budget.
At the six-month mark of our budget year, which was in December, we looked to see where we were, because we had projected a significant deficit budget for this year. We almost always have a deficit budget going into the year, because I’m very realistic. I’m very conservative when it comes to income projections and very liberal when it comes to expenses. So I always want to project the worst-case scenario budget so that there will never be any surprises for the board. “So here’s the worst-case scenario: can you stomach this?” That’s my approach. So maybe that’s our contingency plan. Every year, in our budgeting process, we present the worst-case scenario budget, and we never have a deficit that we can’t cover with our reserves.
When we looked at things in December, and then in January, and now in February, we are shockingly still in the black for the year. We don’t expect to be at the end of the year; but we also don’t expect to be anywhere near the deficit that we had projected. So we don’t really have to implement any kind of draconian measures at this point.
Bi-Lingual International Assistant Services
St. Louis, Missouri
On the other hand, Bi-Lingual International Assistant Services (BIAS) of St. Louis, Missouri, entered this era in dire straits. The six-year-old organization was founded by the CEO, Julia Ostropolsky, who watched her own grandparents struggle with the complexities of aging in the United States as non–English-speaking Russian Jewish immigrants. Ostropolsky describes the work of BIAS as offering mental health, social, and advocacy services to elderly, disabled, and new Americans in a culturally and linguistically accessible way. According to Ostropolsky, “We are cultural brokers providing services with deep understanding and appreciation for consumers’ cultural backgrounds and individual life experiences. Most of the agency’s consumers are women of ethnic and racial minorities.”
The agency is built on the model of home-based, integrated, targeted, case management services whose efficacy has been well proven for very poor and marginalized families and individuals. Recognized for its innovative practice with the Bosnian, Kurdish, Afghani, and Russian Jewish communities, BIAS was one of 11 organizations recognized by the Commonwealth Fund. Still, Ostropolsky reports that the organization will be lucky to receive even a third of what it received in funding last year. Ostropolsky lists the cuts the organization has made. One foundation it had depended on (ASC) closed altogether. “What [do] I worry about?” Ostropolsky says.
Without our assistance and tutoring, they are likely to never become U.S. citizens, lose SSI [Social Security Income] and therefore have no income at all. What keeps me up at night is knowing that once we heard that our program was held up, several [already naturalized] older adults from Russia and Afghanistan came forth and gave of their limited income [SSI] donations in the total amount of $300.
Tears came to our eyes as we took the money, knowing that those who gave it could hardly have enough to survive. What keeps me up at night is the realization that I am ultimately responsible for the well-being of the organization I founded, and the team that trusts me and volunteers their own time to meet the needs of the consumers we serve.
Instead of cutting the program, I held an emergency meeting and invited staff to volunteer as much of their income by taking a pay cut as they can afford. All volunteered, because in a small agency such as ours, none would want to see their colleague go, especially at such difficult economic times. We are known as “workaholics”—people who put clients first—and [have] a great, forgiving and supporting family of Vietnamese, Russian, Bosnian, American, Chinese, Afghan, Hispanic, Japanese, and Jewish staff. It took years to hire the most dedicated, expert group of people, and now I am very worried that I may be losing my ability to ensure their funding.
Ostropolsky reports that she cut her own salary by $10,000 without permission from the board, which wanted to know why she did not ask first.
Editors’ note: Since the initial interview from which this material was written, BIAS was informed that the program it had maintained with all its savings funds would receive state funding, but with severe cuts from the original award.
Jersey Battered Women’s Service
Morristown, New Jersey
With 23 vigilant souls on the board, Jersey Battered Women’s Service (JBWS) has a lot more wiggle room, to say the least. A 32-year-old $3.5 million organization in the second most wealthy county in New Jersey, this organization until recently boasted a year’s worth of reserves in the bank, though it has recently fallen below 10 months’ worth. It has been on a gentle growth trajectory for a few years, mostly because of natural expense increases but also because it has gradually added programming, The level of JBWS’s reserves, says Executive Director Patty Sly, is gauged against the number of facilities that it has and the entirety of the organization’s vulnerability to unexpected problems.
The organization’s mix of funding is approximately 30 percent from various government sources, 40 percent from foundations and corporations, and 30 percent from individuals. JBWS heeded advice about the need to diversify its funding base, though the staff now says that given the current circumstances, the strategy does not protect the organization as well as it would have liked. The fact is that many of the sources in that diverse base have shown decline. The state of New Jersey has a “tremendous deficit,” Sly says, and while JBWS knows some of what to expect in terms of state budget cuts, it doesn’t know all of it. JBWS was just notified that its most recent grant awarded by the state will not be renewed when its funding cycle ends in June. The annual appeal came in at 18 percent less than the previous year. Over the past few years, United Way funding has declined and in 2009 continues to slide. JBWS is still bracing for the results of each of its foundation requests but expects declines there as well. Each of these sources, of course, has its own reporting system, taking up the same amount of time on lesser money for application, measurement, and reporting.
Sly reports that JBWS is exploring where to cut and improve efficiency. Although it knows that staff salaries have to be considered, right now it depends on attrition and benefit reductions, but “we are really evaluating that monthly.”
So what of the reserves? Sly says that at first the board did not want to use them. “Some board members said, ‘We have to save them for a rainy day,’ and others said, ‘But isn’t it raining?’” The board finally decided that the organization could use the reserves, but only in concert with a cost reduction plan and a multiyear plan to rebuild the reserves. She believes that the board was ready for this dialogue, though, because it created its strategic plan this fall and for the first time “it reads like a protective rather than a growth-oriented plan. No other plan we’ve done has ever read like that.”
Domestic and Sexual Abuse Services
Three Rivers, Michigan
In the same field but in a much poorer area is Domestic and Sexual Abuse Services (DASAS) in Three Rivers, a small town in rural southwest Michigan. With the highest unemployment rate in the country, the state has its own budget problems, which trickle down to nonprofits. Characterizing the organization’s budget trend over the past five years, Executive Director Mary Lynn Falbe says, “Our expenses have gone up while our income has gone down.” Over these five years, there has been a steady turnover of executives following the departure of a longtime director who had strongly influenced the organization. Even as the number of women being served increased to almost 300—“and that is not counting the children”—the funding declines continued. United Way funding was one of these decreases. The excruciatingly Michigan nature of the story behind that situation clearly exhibits why geography is important.
“One of our large employers in Three Rivers is American Axle [& Manufacturing], and they went on strike last year,” Falbe says. “They are usually the largest giver to United Way. So when they were out of work, the pledges did not come in, so our funding was cut by almost a third.” Ironically, so were the wages of American Axle workers, who went back to work after 87 days and after agreeing to a one-third pay cut. Originally, a 50 percent pay cut was proposed. American Axle is a major supplier to General Motors, which now faces bankruptcy and massive restructuring.
Last year this organization experienced a small miracle. It was facing a year-end $44,000 deficit. But suddenly, a bequest of which the organization had no institutional memory was released by the IRS. “Now, as a result of that and another gift we had not expected, we have been able to fix the roof and lift salary freezes, and we have a surplus of $30,000.”
Every day, DASAS collaborates quite a bit, partly because working together is natural in such a small community and partly because it must do so to survive. DASAS not only works closely with other domestic violence programs throughout Michigan to ensure the safety of the families being served but also shares tasks with other local nonprofits. For instance, it rents space from Head Start for its administrative office for $50 a month while also providing an awareness program for the parents of children in the program. The organization is strategic about where it focuses its programmatic attention. “Our focus is on advocacy,” Falbe says. “We don’t have therapists, so we use other community resources for those needs.”
Today, this small organization’s mix of cash funding is 5 percent from the United Way, 20 percent from donors (individual and businesses), 10 percent from foundation grants, and 60 percent from federal and state funding.
“In terms of the economy, we can talk about our sources of funding as having been impacted and squeezing us from one direction,” says Mark Weiner, the CEO of CJE SeniorLife in Chicago, Illinois, “but we have to also talk about what has happened to our clients, our residents, and our customers. People are entering our systems with a higher level of acuity—more intensive needs and less ability to pay. They are applying for financial support quicker than they have in the past, and that places in question the issue of how to balance our payer mix in the future. We try to make sense of it all and to minimize cutting into our core services.”
CJE SeniorLife is a $54 million organization with 600 full-time and 150 part-time employees. Previously CJE stood for the Council for Jewish Elderly. While the organization still identifies strongly with its Jewish values, CJE provides an impressive variety of health, housing, educational, and other services to elderly Chicagoans of all stripes.
Weiner has been at the organization for five years, during which time it has grown from a $38 million annual budget to its current size, but prior to his arrival, CJE had already been in a fairly steep climb. “The previous leadership,” Weiner, says, “built this small social-service agency into a very complex and diversified elder-care organization.” But as with almost any type of rapid growth, important steps to support that growth fell off the radar. Organizational infrastructure, particularly for collection of receivables, lagged behind the organization’s overall trajectory, and CJE ended up in debt. These management problems have since been resolved, but now the environment is pressing in.
CJE is being affected not just by cutbacks but also by flat-rate reimbursements and late payments by government sources. These days, borrowing on its credit line costs the organization approximately $60,000 a year. But the organization has also seen a decline in fundraising from individuals and foundations. Among individuals, CJE’s fundraising has decreased by about 25 percent, and contributions from foundations may be headed in the same direction. Weiner cites the fact that one foundation from which it has received $100,000 in past years simply closed its doors.
In public funding, Weiner has plenty to track, and some of the items are very high stakes.
The real problem for us is Medicaid with the state of Illinois. In terms of what the state pays nursing homes, we’re 50th out of 50 states. Although we recently received a small rate increase from the state, every time we have a Medicaid bed filled, the difference between what the state pays us and the true cost is $90. We have a 240-bed nursing home that is about 60 percent Medicaid. That puts a real burden on the nursing home as well as our entire system. We would just be happy if they paid us.
And we’re also depending upon the state of Illinois for two other things. We have a naturally occurring retirement community project site that came originally from federal funding. That transferred over to state funding. We believe we’re going to get continued funding from the state for that project, but there’s no certainty of it. And then we have something called MCCP, which is a managed community care program, in which we provide sort of a social model to keep the poorest of the poor older adults at home and in the community. On a regular basis, MCCP staff members serve about 550 people per month, and we provide them up to 10 services, from home-delivered meals to transportation to adult day services to personal care assistance. We’ve been a pilot program with the state of Illinois now for 14 years, and the program is at risk for long-term funding. Now, that is really very problematic for us, because we are a safe haven for these people, and we are providing the best of managed care in the community to keep these people out of nursing homes. So we’re continuing to get funding for them now, but there’s no certainty of continued funding. So those people become real concerns for us.
CJE is an affiliate of the Jewish United Fund/Jewish Federation of Metropolitan Chicago and is required by it to develop a balanced budget each year. This means that the organization does not have reserves per se, but it does have a significant endowment program, the corpus of which has eroded because of the current economic environment.
“Recently at a meeting with the leadership of the board, the topic of how we were going to achieve a balanced budget next year came up, and this led to a discussion of possible use of endowment principal,” Weiner says. “Historically, we have tried not to invade principal, but the chair of our budget committee made the point that these are extraordinary times, and we may need to. Our major objective is to protect the core of our business and, to the greatest extent possible, guard against any lessening of our ability to deliver those services to our community.”
CJE’s new budget for the year, which starts July 1, includes staff reductions, and right now these cuts are quite limited, targeting just 20 positions out of 750. With these reductions, Weiner does not anticipate using endowment principal, but he may reconsider it later as a contingency option.
Northshore Senior Center
In Bothell, Washington, the 37-year-old Northshore Senior Center, which has a $3 million budget, now has to consider multiple cuts. Lee Harper, the relatively new executive director, reports that starting in July, the organization began scenario planning, estimating that the cuts for 2009 might amount to $200,000. She approached this planning in part as a way to familiarize and engage the board more fully in agency finances.
We spent months talking about the different areas where we could increase revenue, where we’d need to decrease expenses, what an end budget might look like. I asked the board to get involved with advocacy, and they did! They went down to the county council hearings, and they wrote letters. They really stepped it up, and we ended up getting $100,000 of it back. But now, at the legislative level, we may be faced with anywhere from a 10 percent to a 50 percent cut, and another $100,000 will be disappearing on top of that at the end of the year. It’s pretty overwhelming.
Like CJE’s Weiner, Harper has noticed an increased call for financial support for clients, which will reduce earned income as well.
Meanwhile, this is clearly an organization with strong local support. After creating a junior taxing district, the voters elected to tax themselves to build the senior center and then also to build a health and wellness center for local seniors, so the organization now does business out of $8.5 million worth of facilities but faces what could be a massive cut in operating funds. The organization has unrestricted reserves that equal about one-tenth of the year’s operating budget.
Since she is keyed in to local capacity builders and a supportive community, Harper is making use of available advice. She is confident her center will survive in spite of the wrenching changes that lie ahead.
Editors’ note: At the time of this writing, Harper reports, “Now, at the legislative level, we are facing a $900,000 funding cut for adult day health and transportation (a 90% cut) and another $100,000 will be disappearing on top of that at the end of the year from the county.”
Higher Achievement is a 33-year-old organization that provides rigorous year-round academic enrichment to middle-school students in the Washington, D.C., area. But the organization’s age and history comes with a caveat: in 1998 it was pretty much pronounced dead. It ceased operations; and at the time it was $300,000 in debt. Still, Maureen Holla, a volunteer in the program when it went under, did not give up hope, and in 1999, as its new executive director, Holla reopened the program.
Since mid-2006, Richard Tagle, the current executive director, has been at Higher Achievement, and at that time the organization had established four sites in Washington, D.C., and was about to launch a fifth in Virginia. “When I came in, the organization had a budget of $1.6 million and a staff of 18. A lot of our funding was garnered from local foundations and corporations.” Since Tagle took the helm, Higher Achievement has expanded into Baltimore.
In the two years since, Higher Achievement’s budget has grown to $4.7 annually, but some of this growth is allocated toward onetime costs associated with what was originally an aggressive replication plan as well as a longitudinal study. First priced at $20 million, that replication strategy has now been scaled back to a more measured expansion plan, priced at $11 million. The difference between the two is the number of sites to be established by 2020 and the nature of the partnership agreement between Higher Achievement and the sites. The sites will now be required to invest more cash in implementation. In terms of the organization’s base program, Tagle estimates that approximately $2.3 million is slated for direct service at each fully scaled affiliate, and the rest is meant to capitalize expansion to other cities.
Higher Achievement has experienced a downturn in revenue, but also success in exploring new avenues. These triumphs and setbacks come in bits and pieces. Over the past three years, Freddie Mac has contributed $250,000 a year; Fannie Mae had been giving $50,000, but this year gave none. And individual and foundation funding to the base program has probably decreased 20 percent to 25 percent, but on the other hand the organization has managed to offset that with new corporate contributions (mobilized by the board) and some newly available Department of Education money as well as increased attention toward public revenue streams, such as Title I and 21st Century Community Learning Centers.
During the economic crisis, Higher Achievement has experienced its dramatic moments.
We needed a little over $1 million to finish the funding for a multiyear study we were doing on our ou